PCS Lease Process Form

Please read our compliance statements

School or Facility*

First Use Date*

Date

Last Use Date*

Date

Full Legal name of individual or group leasing the school*

(Name of the “insured” as it appears on the certificate of Liability Insurance)

If this is an athletic team, is this an outside group or school based off-season team?*

Full mailing address of leasing individual or group. - No P.O. Boxes*

Contact Person for Lease*

First NameLast Name

Daytime phone number of contact person*

Please enter a valid phone number.

E-mail for contact person*

example@example.com

Describe the nature of the use or activity*

Is the individual or group 501(c)(3)non-profit? If yes a letter must be sent to leasing office prior to approval.*

YesNo

If booster fundraiser, will funds run through school acct. or booster acct.?*

YesNo

Rooms, fields, stadiums, ball-fields, pool, etc., to be used. Completely list the facilities, associated dates, and times of their use. Please be thorough to prevent additional follow-up which may lead to processing delays.

Rooms & Fields to be used*

Enter any equipment that will be provided to lessee (i.e. stage lights/spotlights, audio/visual type, sporting equipment type; computers; musical instruments, etc.)

Dates of Use*

Total Number of Days*

How many people are expected to attend the event*

Time you will arrive at facility *

(This is not the time the event starts) Minutes Minutes

AM/PM Option

Time you will leave facility *

(This is not the time the event will end) Minutes Minutes

AM/PM Option

Enter any outside lighting, lining of field, pool heater use required/needed

Will set-up and or clean-up be required for plant operator staff (i.e. setting up chairs, tables, etc.)?*

Name of person/administrator at school who has approved your request for this lease.*

First NameLast Name

Position of individual at school.*

If you have not received approval from a school district employee do not submit this form. Submittal of lease information without school district approval may result in the cancellation of the facility use.